This blog is dedicated to the University of Vermont Center for Clinical and Translational Science and especially its Education and Career Development Programs. We hope it will be a useful tool for CTS faculty, Graduate Students and Faculty Scholars to keep in touch, share ideas, create community, and do science.

1.Start Up: Introductions and welcome to Whitney Calkins
from Family Medicine.

2.Presentation: Rodger:
The Department of Family Medicine has invited research proposals as part of the
Transformation project, to be presented to Academy of Family Practice (1 year),
to be followed by a broader project (2 years).Goal: engage FM faculty in research.

a.Can patient engagement and population adherence to EBM
guidelines be affected by development and implementation of a patient-centered
'MyActionPlan' that builds upon technology through large-scale health
assessment data collection?"

i.My Action Plan is an EMR
generated document for the patient to take home, in support of shared decision
making, e.g. to take cardiovascular medications, etc.Probably exists as a separate tab from the
AVS (After Visit Summary) to highlight what was most important to the patient
in support of good health.

ii.Long term: Wilson Pace is
bringing together investigators across the NRN who are building similar
assessment tools.

b.Question: Can we develop and implement a tool within
PRISM to improve both population care and patient engagement specifically
improving reliability of cardiovascular disease management. (To be implemented
in one FM practice for this study.)

iii.The evaluators/funders (Tom and John) are in support of
this product development focus.Resource:
.25 FTE protected faculty time, with the support of PRISM developers to the
extent needed.This depends
significantly on organizational decision making.

iv.Consider the construct: does goal setting affect
behavior?This can be tested on paper
and does not necessarily depend on an EMR intervention (e.g. SMART goal
setting; Excel spreadsheet 10 year projections related to patient risk
factors).There are also current web
based interventions: MyHealth.com

1.The
current literature indicates that goal setting in the provider office has
limited support in connection with health outcomes.

2.Self-efficacy
literature does support links to positive outcomes, which links this work to a
larger model of prevention effectiveness.

v.Possible focuses (#1 below grew to be highest in
interest):

1.Collect
data for patient goal setting and report – is this Novel?Maybe good for infrastructure, if not of
national interest.Should be
publishable.

a.30
minute visit

b.Structure
conversation, e.g. SMART

c.Specific
to the patient’s selected issue (EtOH,…) – select which THIS project will focus
on

2.Report/plan
goes with patient

3.Report
in PRISM

4.Self-efficacy:
patient belief/feeling about their ability to change

5.Develop
a SmartForm to support EBP patient care and generate an action plan (clinical
decision support).Test as to whether it
has an effect on patients.

a.Physician
use of SmartForm likely to be low

vi.Approach

1.Develop
on the conference table/role plan

2.Pilot
in one clinic with one/few providers

3.Develop
as a PRISM specification (in the future)

vii.Evaluate

1.Validation
by patients in response to whatever the focus is producing, e.g. a standard
goal setting exercise

2.Identify
a measure for change in “patient engagement”

3.Include
measures that matter to your future audiences: cost, time, and utilization

a.Sept 27: Charlie on ways to analyze and understand
narcotic prescribing in VT through various data sources and various ways to
summarize and present data that are useful to clinicians. This generalizes to
other medication categories as well and overlaps with Amanda's Medication
Management Project. (No Amanda)

a.Abby
has written the background and methods sections of her manuscript.She provided a draft table 1 with 24
variables, each of which may have a different “n” as the denominator value for
that variable.(That is, some birth
records are missing some fields of data, and this varies by variable.Furthermore, some variables are natural
subsets, like whether the mother was in treatment or not, and necessarily have
smaller n’s.)These variables are also
the predictors in the study she is doing to find predictors of NAS (Neonatal
Addiction Syndrome).

b.The
question: what is the best way to present such a long table, especially since
the n’s changes so much.Suggestions:

i.Add a column for every variable to present the real n

ii.Group variables into 4 tables, each representing a
concept (infant, environment, mother, substance abuse), with the infant as the
starting point

iii.Tell the story using the tables

c.We
had an ongoing side-bar conversation about how the thinking process necessary
to keep all these variables “in focus” might or might not be assisted by using
the presentation software Prezi.Rodger
agreed to work through a demo of Prezi and bring it to CROW sometime in the
near future.

b.Sept 27: Charlie on ways to analyze and understand
narcotic prescribing in VT through various data sources and various ways to
summarize and present data that are useful to clinicians. This generalizes to
other medication categories as well and overlaps with Amanda's Medication
Management Project.

Wednesday, September 12, 2012

1.Start Up: Charlie attended a good initial meeting of a
Health Dept advisory group on pain management – a receptive group, with a new
and very interested analyst.New
limitation of VPMS: the largest prescriber in the state (of opiates) is FAHC,
unspecified.(This probably refers to ED
discharges and resident patients.)This
is because the vendor drops the identifying information in the provider
field.

2.Presentation: Kairn:
what does probability mean in the context of inter-rater agreement

a.Probability
has 2 schools of thought (per Ben):

i.Traditional: A probability is a fact, that is represented
by the average and standard deviation of real world trials.Usual example: coin toss.

ii.Bayesian: A probability is an opinion, or a prediction,
about the world, that is more/less well informed.Each is conditional, based on other
probabilities.Usual example: card game.

b.Kairn
presented an “ice cream cone” graphic to present the relationships that are
possible of the two raters in her study in their agreement, resulting in “pass
rate” outcomes

i.Each of the 200 words can be evaluated based on the
goodness of their inter-rater agreement (there were 34 subjects, each rated by
two raters)

ii.We can hypothesize an ideal level of agreement (97%
based on the mean in this data set) to evaluate the goodness of the word in
auditory testing (within child agreement).Note: none of the words rated worse that random agreement.

iii.Bland-Altman plots the difference of the pass-rate from
each word for both raters over all the children rated. (Difference in average
pass rates per word.)

b.Sept 20: Charlie on ways to analyze and understand
narcotic prescribing in VT through various data sources and various ways to
summarize and present data that are useful to clinicians. This generalizes to
other medication categories as well and overlaps with Amanda's Medication
Management Project.

iii.Journal Club: “Methods and metrics challenges of
delivery-system research,” Alexander and Hearld, March 2012 (for later in the
year?).UVM authors who have published
interesting design articles (Kim, Osler)

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The Vermont Center for Clinical and Translational Science

We offer training in Clinical and Translational Science to undergraduate, graduate and post-graduate students, including a Graduate Certificate, the MS in Clinical Investigation, the MS in Research Management, a special MS track for surgical residents, and the PhD. Find out more about our graduate programs here.

Spring 2018 Schedule

Seminar in Clinical and Translational Science

Fridays

12:00 PM - 1:15 PM

Given Courtyard S359

Workshop in Clinical Research (CROW)

Thursdays

11:00 AM - 12:00 PM

Given Courtyard S457 (FRED)

What the authorities say...about authority

What has occurred over the course of the last few centuries is a growing (but by no means universal or certain) recognition that science gets the job done, while religion makes excuses. Sometimes they are very pretty excuses that capture the imagination of the public, but ultimately, when you want to win a war or heal a dying child or get rich from a discovery or explore Antarctica, you turn to science and reason, or you fail. -PZ Myers, biology professor (b. 9 Mar 1957)

Most institutions demand unqualified faith; but the institution of science makes skepticism a virtue.

- Robert King Merton (1910-2003)

One should as a rule, respect public opinion in so far as is necessary to avoid starvation and to keep out of prison, but anything that goes beyond this is voluntary submission to an unnecessary tyranny, and is likely to interfere with happiness in all kinds of ways...

- Bertrand Russell (1872-1970)

In all life one should comfort the afflicted, but verily, also, one should afflict the comfortable, and especially when they are comfortably, contentedly, even happily wrong.

- John Kenneth Galbraith (1908-2006)

Historically, the claim of consensus has been the first refuge of scoundrels; it is a way to avoid debate by claiming that the matter is already settled.- Michael Crichton (1942-2008)

Unthinking respect for authority is the greatest enemy of truth.-Albert Einstein (1879-1955)

In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual.-Galileo Galilei (1564-1642)

Every great advance in natural knowledge has involved the absolute rejection of authority.